Streptococcal myositis is an extremely uncommon infectious disease that is caused by Group A Streptococcus (GAS). A GAS infection spreads rapidly and diffusely through the muscle, resulting in edema and necrosis. This can lead to streptococcal toxic shock syndrome with an extremely high mortality. We report a 42 year-old female patient with Streptococcal myositis accompanying with systemic lupus erythematosus who initially presented with fever, severe pain, and tenderness on the calf without any prodromal symptom of myositis. Despite the aggressive management, her general symptoms were aggravated and she died 7 days later as result of the toxic shock syndrome.
Background: Compaction bone-grafting has been suggested as a means of improving the stability of the humeral component in shoulder arthroplasty, but the clinical and radiographic results of the procedure have not been reported in the literature, to our knowledge. To address this deficit, we report on a series of shoulder arthroplasties performed with compaction bone-grafting to secure humeral component fixation. These prostheses were implanted in shoulders demonstrating a suboptimal interference fit of the humeral component. Methods: Fifty-eight shoulders in fifty-three patients were treated with prosthetic shoulder arthroplasty that included compaction bone-grafting. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort and function, and overall quality of life, and with use of patient self-assessments including the American Shoulder and Elbow Surgeons Score and the validated Simple Shoulder Test. A detailed radiographic analysis was performed by three raters to determine whether radiolucent lines were present immediately postoperatively and at a later follow-up interval. The humeral tilt angle was determined by measuring the angle between the humeral axis and the component. Subsidence was also evaluated. The mean of the raters' measurements was used in the analysis. Results: The mean duration of follow-up was sixty-nine months (range, twenty-six to 148 months). No loose stems were observed, and no humeral component was revised. At the time of follow-up, there was significant improvement in the Simple Shoulder Test scores and all visual analog scores (p < 0.0001 in each instance). Thirty-four stems had no radiolucent line at the time of follow-up, and the mean maximum thickness of the lucent lines was 0.21 mm in the entire group of fifty-eight shoulders. Most lucent lines occurred near the distal stem tip. The mean tilt of the valgus and varus humeral components was 2.2° and 2.6°, respectively, on the immediate postoperative radiographs. No humeral component shifted from varus to valgus or vice versa. The duration of follow-up was not correlated with the maximum thickness of the humeral component lucency, and the presence or absence of a prosthetic glenoid was also unrelated to the maximum thickness of the lucency. Conclusions: Compaction bone-grafting in shoulder arthroplasty can yield stable and durable fixation of the humeral component, as seen clinically and radiographically, without use of cement. Our findings provide evidence that compaction bone-grafting in shoulder arthroplasty is an option to ensure intermediate-term fixation (at a mean of five years) of humeral components that have a suboptimal fit. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
Purpose : The purpose of this study was to investigate the efficasy of dorsal percutaneous Acutrak screw fixation for acute stable or unstable scaphoid fractures. Materials and Methods : We assessed 7 cases of acute scaphoid fracture from January 2001 to Febrary 2002, 5 cases were of acute stable fracture (Herbert type A2) and 2 cases were of unstable minimal displaced fracture (Herbert type B2). All were treated by dorsal percutaneous Acutrak screw fixation. The postoperative management protocol involved removing the splint at postoperative 1 week, this was followed by active and strengthening exercise. Patients returned to work at a postoperative 2 weeks, and a follow-up study 7 cases from 12 to 20 months (average 15.8 months). Results : According to tenderness at the anatomical snuff box, pain during range of motion of the wrist joint and the Maudsley scale, 6 cases (Herbert type A2: 5 case, Herbert type B2: 1 case) were excellent and one case (Herbert type B2) was good. Conclusion : Dorsal percutaneous Acutrak screw fixation is useful method for acute stable or minimal displaced scaphoid waist fractures, because it reduces complications due to prolonged cast immobilization.
Purpose: Many different operative technique of mid-shaft clavicle fracture have been reported.The aim of this prospective study was to compare the results of anterior or anterior-inferior plating with superior plating on the acute mid-shaft fracture of clavicle Materials and Methods: From February1997 to February 2002, thirty-eight consecutive open reduction and internal fixation with reconstruction plates were performed in thirty-eight patients.From August 1999, anterior or anterior-inferior plating was mainly used, prospectively.The duration of follow-up averaged 17 months (range, 23 to 43 months).The mean age was 38 years old (range, 21 to 57 years old) on anterior or anterior-inferior plating group and 35 years old (range, 24 to 55 years old) on superior plating group.The physician progress note, VAS patient complement score, Roentgenogram and ASES score was evaluated.Results: Four patients were lost to follow-up.There was no statistical difference on mean radiological bone union time (8.7 weeks vs. 8.6 weeks) and ASES score (92 vs 94) at inferior and superior plating groups (P > 0.05).VAS patient complement score was very good or excellent on anterior or anterior-inferior group, average score was 1.1 (range, 0 to 2) compare with superior plating group (P < 0.05).There were two cases of infection, 1 case of failed fixation on superior plating group and 1 case of delayed union on anterior inferior plating group.Conclusion: Anterior inferior plating on acute clavicle midshaft fracture results in excellent patient complement score compare with conventional superior reconstruction plate.
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